Song Panai, Yang Dong, Li Jine, Zhuo Ning, Fu Xiao, Zhang Lei, Zhang Hongqing, Liu Hong, Sun Lin, Liu Yinghong
Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China.
Front Med (Lausanne). 2022 Apr 14;9:799110. doi: 10.3389/fmed.2022.799110. eCollection 2022.
The number of elderly patients on peritoneal dialysis (PD) has rapidly increased in the past few decades. We sought to explore the microbiology and outcomes of peritonitis in elderly PD patients compared with younger PD patients.
We conducted a retrospective study to analyze the clinical characteristics, causative organism distribution, and outcome of all PD patients who developed peritonitis between September 1, 2014 and December 31, 2020, from Second Xiangya Hospital, Central South University, China. Patients who experienced peritonitis were separated into elderly and younger groups. The elderly was defined as ≥ 65 years old at the initiation of PD.
Among 1,200 patients, 64(33.9%) in elderly ( = 189) and 215 (21.3%) in younger ( = 1,011) developed at least one episode of peritonitis. A total of 394 episodes of peritonitis occurred in 279 patients. Of these, 88 episodes occurred in 64 elderly patients, and 306 episodes occurred in 215 younger patients. Gram-positive bacteria were the main causative organisms in elderly and younger patients (43.2% and 38.0%, respectively). Staphylococcus and Escherichia coli were the most common gram-positive and gram-negative bacteria, respectively. Fungal peritonitis in elderly patients was higher compared with younger patients (χ2 = 6.55, = 0.01). Moreover, Acinetobacter baumannii (χ =9.25, = 0.002) and polymicrobial peritonitis (χ = 6.41, = 0.01) in elderly patients were also significantly higher than that in younger patients. Additionally, elderly PD patients had higher peritonitis-related mortality than younger patients (χ = 12.521, = 0.000), though there was no significant difference in catheter removal between the two groups. Kaplan-Meier analysis showed that cumulative survival was significantly lower in elderly patients than younger patients (log rank = 7.867, = 0.005), but similar technical survival in both groups (log rank = 0.036, = 0.849).
This retrospective study demonstrated that elderly PD patients were more likely to develop Acinetobacter baumannii, fungal and polymicrobial peritonitis than younger PD patients. In addition, peritonitis-related mortality was significantly higher in elderly patients, whereas peritonitis-related catheter removal was comparable between elderly and younger PD patients. Understanding microbiology and outcome in elderly patients will help to reduce the incidence of PD-associated peritonitis and improve the quality of life.
在过去几十年中，接受腹膜透析（PD）的老年患者数量迅速增加。我们试图探讨老年PD患者与年轻PD患者相比腹膜炎的微生物学情况及预后。
我们进行了一项回顾性研究，分析了2014年9月1日至2020年12月31日期间在中国中南大学湘雅二医院发生腹膜炎的所有PD患者的临床特征、病原体分布及预后。发生腹膜炎的患者被分为老年组和年轻组。老年患者定义为开始PD治疗时年龄≥65岁。
在1200例患者中，老年组（n = 189）有64例（33.9%）发生至少1次腹膜炎，年轻组（n = 1011）有215例（21.3%）发生至少1次腹膜炎。279例患者共发生394次腹膜炎发作。其中，64例老年患者发生88次发作，215例年轻患者发生306次发作。革兰阳性菌是老年和年轻患者腹膜炎的主要病原体（分别为43.2%和38.0%）。葡萄球菌和大肠杆菌分别是最常见的革兰阳性菌和革兰阴性菌。老年患者真菌性腹膜炎的发生率高于年轻患者（χ2 = 6.55，P = 0.01）。此外，老年患者鲍曼不动杆菌感染（χ = 9.25，P = 0.002）和混合性腹膜炎（χ = 6.41，P = 0.01）的发生率也显著高于年轻患者。另外，老年PD患者腹膜炎相关死亡率高于年轻患者（χ = 12.521，P = 0.000），尽管两组在拔除导管方面无显著差异。Kaplan-Meier分析显示，老年患者的累积生存率显著低于年轻患者（对数秩检验 = 7.867，P = 0.005），但两组的技术生存率相似（对数秩检验 = 0.036，P = 0.849）。
这项回顾性研究表明，与年轻PD患者相比，老年PD患者更易发生鲍曼不动杆菌、真菌及混合性腹膜炎。此外，老年患者腹膜炎相关死亡率显著更高，而老年和年轻PD患者腹膜炎相关导管拔除情况相当。了解老年患者的微生物学情况及预后将有助于降低PD相关腹膜炎的发生率并提高生活质量。
